II 

118TH CONGRESS 

2D SESSION S. 4094 

To amend title XVIII of the Social Security Act to provide for coverage 

of the Medicare Diabetes Prevention program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 10, 2024 

Mr. SCOTT of South Carolina (for himself, Mr. WARNER, and Mr. CRAMER) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for coverage of the Medicare Diabetes Prevention program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Promoting Responsible 

5 and Effective Virtual Experiences through Novel Tech6 nology to Deliver Improved Access and Better Engage7 ment with Tested and Evidence-based Strategies Act’’ or 

8 the ‘‘PREVENT DIABETES Act’’. 


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1 SEC. 2. MEDICARE DIABETES PREVENTION PROGRAM. 

2 (a) COVERAGE.— 

3 (1) IN GENERAL.—Section 1861 of the Social 

4 Security Act (42 U.S.C. 1395x) is amended— 

5 (A) in subsection (s)(2), by adding at the 

6 end the following new subparagraph: 

7 ‘‘(KK) diabetes prevention program services (as 

8 defined in subsection (nnn));’’; and 

9 (B) by adding at the end the following new 

10 subsection: 

11 ‘‘(nnn) DIABETES PREVENTION PROGRAM SERV12 ICES.— 

13 ‘‘(1) IN GENERAL.—The term ‘diabetes preven14 tion program services’ means structured behavioral 

15 health change sessions that— 

16 ‘‘(A) are furnished to an eligible individual 

17 described in paragraph (2) by a diabetes pre18 vention program supplier for the purpose of 

19 preventing or delaying the onset of type II dia20 betes; 

21 ‘‘(B) follow a CDC-approved curriculum; 

22 and 

23 ‘‘(C) are furnished on or after January 1, 

24 2025. 


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1 ‘‘(2) ELIGIBLE INDIVIDUAL DESCRIBED.—An 

2 eligible individual described in this paragraph is an 

3 individual that— 

4 ‘‘(A) is entitled to benefits under part A 

5 and is enrolled under part B; 

6 ‘‘(B) has no previous diagnosis of diabetes 

7 (other than gestational diabetes); 

8 ‘‘(C) does not have end-stage renal disease; 

9 and 

10 ‘‘(D) meets additional medical criteria 

11 specified by the Secretary. 

12 ‘‘(3) NO LIFETIME LIMIT ON PARTICIPATION.— 

13 There shall be no limitation on the number of times 

14 an eligible individual may enroll in the diabetes pre15 vention program.’’. 

16 (2) CONFORMING CHANGE.—Section 1862(a)(1) 

17 of the Social Security Act (42 U.S.C. 1395y(a)(1)) 

18 is amended— 

19 (A) in subparagraph (O), by striking 

20 ‘‘and’’ at the end; 

21 (B) in subparagraph (P), by striking the 

22 semicolon at the end and inserting ‘‘, and’’; and 

23 (C) by adding at the end the following new 

24 subparagraph: 


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1 ‘‘(Q) in the case of diabetes prevention program 

2 services (as defined in section 1861(nnn)(1)), which 

3 are furnished to an individual who is not an eligible 

4 individual (as defined in section 1861(nnn)(2));’’. 

5 (b) DIABETES PREVENTION PROGRAM SUPPLIERS.— 

6 Section 1866 of the Social Security Act (42 U.S.C. 

7 1395cc) is amended by adding at the end the following 

8 new subsection: 

9 ‘‘(l) DIABETES PREVENTION PROGRAM SUP10 PLIERS.— 

11 ‘‘(1) DIABETES PREVENTION PROGRAM SUP12 PLIER.—In this subsection, the term ‘diabetes pre13 vention program supplier’ means an entity that— 

14 ‘‘(A) is recognized under the Centers for 

15 Disease Control and Prevention Diabetes Pre16 vention Recognition Program and offers a pro17 gram through an allowable Diabetes Prevention 

18 Recognition Program delivery mode including 

19 in-person, online, distance learning, combina20 tion, and other synchronous and asynchronous 

21 modalities as determined by the Secretary; 

22 ‘‘(B) is enrolled under the diabetes preven23 tion program in accordance with paragraph (2); 

24 and 


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1 ‘‘(C) meets the requirements described in 

2 paragraph (2)(B). 

3 ‘‘(2) ENROLLMENT IN DIABETES PREVENTION

4 PROGRAM.— 

5 ‘‘(A) APPLICATION.—An entity seeking to 

6 enroll as a diabetes prevention program supplier 

7 under this section shall submit to the Secretary 

8 an application for enrollment at such time and 

9 in such manner as specified by the Secretary. 

10 Such application must meet all elements as 

11 specified by the Secretary. 

12 ‘‘(B) REQUIREMENTS.— 

13 ‘‘(i) ADMINISTRATIVE REQUIRE14 MENTS.—Each diabetes prevention pro15 gram supplier shall maintain— 

16 ‘‘(I) administrative requirements 

17 as outlined by the Secretary; 

18 ‘‘(II) active enrollment as a dia19 betes prevention program supplier 

20 under subsection (j); and 

21 ‘‘(III) at least one administrative 

22 location. 

23 ‘‘(ii) DOCUMENTATION; DATA SUBMIS24 SION.— 


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1 ‘‘(I) DOCUMENTATION.—Each di2 abetes prevention program supplier 

3 shall maintain documentation in ac4 cordance with standards specified by 

5 the Secretary. 

6 ‘‘(II) DATA SUBMISSION.—Each 

7 diabetes prevention program supplier 

8 shall maintain information as speci9 fied by the Secretary and submit it to 

10 the Secretary in the form and manner 

11 specified by the Secretary. 

12 ‘‘(iii) INSPECTION AND REVIEW RE13 QUIREMENTS.—Each diabetes prevention 

14 program supplier shall allow the Secretary, 

15 or any person or organization designated 

16 by the Secretary, to conduct inspections of 

17 any administrative location of a diabetes 

18 prevention program supplier, or of any eli19 gible setting in which diabetes prevention 

20 program services are furnished, as well as 

21 review all documentation and records 

22 maintained by such supplier for purposes 

23 of the diabetes prevention program. 

24 ‘‘(C) DIABETES PREVENTION PROGRAM

25 SUPPLIER TERMINATION.—The Secretary may 


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1 terminate the enrollment of a diabetes preven2 tion program supplier for purposes of participa3 tion in the diabetes prevention program if such 

4 supplier— 

5 ‘‘(i) fails to meet the requirements de6 scribed in subparagraph (B); 

7 ‘‘(ii) improperly denies services to an 

8 eligible individual (as defined in section 

9 1861(nnn)(2)), including a denial on the 

10 basis of an eligible individual’s weight, 

11 health status, or achievement of perform12 ance goals; or 

13 ‘‘(iii) fails to comply with additional 

14 standards established by the Secretary. 

15 ‘‘(3) ADMINISTRATIVE LOCATION DEFINED.—In 

16 this subsection, the term ‘administrative location’ 

17 means a physical location in which a diabetes pre18 vention program supplier is the primary operator of 

19 such location or the location from which the diabetes 

20 prevention program supplier’s business is run in the 

21 case of an online or combination program, and 

22 where in-person diabetes prevention program serv23 ices may or may not be furnished.’’. 

24 (c) PAYMENT FOR DIABETES PREVENTION PROGRAM

25 SERVICES.— 


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1 (1) IN GENERAL.—Section 1833(a)(1) of the 

2 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

3 amended— 

4 (A) by striking ‘‘and (HH)’’ and inserting 

5 ‘‘(HH)’’; and 

6 (B) in subparagraph (HH), by striking the 

7 semicolon at the end and inserting the fol8 lowing: ‘‘, and (II) with respect to diabetes pre9 vention program services furnished on or after 

10 January 1, 2025, as described in section 

11 1861(nnn), the amount paid shall be equal to 

12 100 percent of the payment amount established 

13 in the payment structure described in section 

14 1834(aa);’’. 

15 (2) PAYMENT STRUCTURE.—Section 1834 of 

16 the Social Security Act (42 U.S.C. 1395m) is 

17 amended by adding at the end the following sub18 section: 

19 ‘‘(aa) PAYMENT FOR DIABETES PREVENTION PRO20 GRAM SERVICES.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall estab22 lish an appropriate payment structure under which 

23 the Secretary shall make payments to a diabetes 

24 prevention program supplier for diabetes prevention 


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1 program services furnished to an eligible individual 

2 (as defined in section 1861(nnn)(2)). 

3 ‘‘(2) ANNUAL UPDATE.—The Secretary shall 

4 update the payment structure under this subsection 

5 annually by the percentage increase in the Consumer 

6 Price Index for all urban consumers (all items; 

7 United States city average) for the 12-month period 

8 ending with June of the preceding year. 

9 ‘‘(3) TERMINATION OF PARTICIPATION.— 

10 ‘‘(A) IN GENERAL.—A diabetes prevention 

11 program supplier may terminate the participa12 tion of an individual participating in the diabe13 tes prevention program if the individual is no 

14 longer an eligible individual (as defined in sec15 tion 1862(nnn)(2)). 

16 ‘‘(B) DOCUMENTATION SUPPORTING TER17 MINATION.—In the case of a diabetes preven18 tion program supplier that terminates the par19 ticipation of an individual participating in the 

20 diabetes prevention program, such supplier shall 

21 maintain records supporting such termination, 

22 including the date of the termination, the rea23 son for the termination, the details of any inci24 dents leading to such termination, any remediVerDate Sep 11 2014 04:39 Apr 17, 2024 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4094.IS S4094

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1 ation efforts taken by such supplier, and any 

2 final actions taken by such supplier. 

3 ‘‘(4) CONTINUATION OF MEDICARE DIABETES

4 PREVENTION PROGRAM EXPANDED MODEL STAND5 ARDS.—Except as specified otherwise in this Act, 

6 the Secretary shall extend the standards of the 

7 Medicare Diabetes Prevention Program Expanded 

8 Model (in effect as of the date of enactment of the 

9 PREVENT DIABETES Act) to govern the diabetes 

10 prevention program. 

11 ‘‘(5) DIABETES PREVENTION PROGRAM.—In 

12 this subsection, the term ‘diabetes prevention pro13 gram’ means the payment structure described in this 

14 subsection.’’. 

15 SEC. 3. SUNSET OF MDPP EXPANDED MODEL. 

16 No payment shall be made for services furnished 

17 under the Medicare Diabetes Prevention Program Ex18 panded Model conducted under section 1115A of the So19 cial Security Act (42 U.S.C. 1315a) after January 1, 

20 2025. 

21 SEC. 4. UPDATE TO REGULATIONS. 

22 Not later than November 30, 2024, the Secretary of 

23 Health and Human Services shall update the regulations 

24 in sections 410.79, 414.84, 424.200, and 424.205 of title 

25 42, Code of Federal Regulations, and any other relevant 


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1 regulations, in accordance with sections 2 and 3 of this 

2 Act. 

3 SEC. 5. REPORT. 

4 Not later than January 1, 2028, the Secretary of 

5 Health and Human Services shall submit to Congress a 

6 report on the diabetes prevention program. Such report 

7 shall include a description of the impact of such program 

8 on— 

9 (1) participation of eligible individuals and dia10 betes prevention program suppliers in the diabetes 

11 prevention program as compared to the Medicare 

12 Diabetes Prevention Program Expanded Model; 

13 (2) weight loss among eligible individuals; 

14 (3) health outcomes of eligible individuals; and 

15 (4) diagnoses and costs relating to type 2 dia16 betes for eligible individuals who have received dia17 betes prevention plan services versus those who have 

18 not. 

Æ 


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